Healthcare Provider Details

I. General information

NPI: 1801868294
Provider Name (Legal Business Name): JODY PETER MCALEER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 W STADIUM BLVD
JEFFERSON CITY MO
65109-6023
US

IV. Provider business mailing address

PO BOX 104240
JEFFERSON CITY MO
65110-4240
US

V. Phone/Fax

Practice location:
  • Phone: 573-556-7724
  • Fax: 573-636-6908
Mailing address:
  • Phone: 573-556-7724
  • Fax: 573-636-6908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number20070005029
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: